Provider Demographics
NPI:1477024784
Name:DAWSON, MERRI-JO NORMAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MERRI-JO
Middle Name:NORMAN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MERRI
Other - Middle Name:JO
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1758
Mailing Address - Country:US
Mailing Address - Phone:231-629-8665
Mailing Address - Fax:
Practice Address - Street 1:203 S STATE ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1758
Practice Address - Country:US
Practice Address - Phone:231-629-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-13
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1041C0700XMedicaid